Medicaid Expansion

Hi everyone! I'm a new member, but I've been engaged in Maine politics for years.

So, I assume nearly everyone here is opposed to Medicaid expansion on the ballot in November. The Maine Heritage Policy Center put out a white paper basically summarizing, I think, the conservative stance on the topic: 1) it's too expensive and 2) we'd be helping people who can help themselves.

I'm conflicted on this issue. I think MHPC brought up some good arguments, but it ignored some opposing evidence. First, we pretty much end up paying for the uninsured anyway. Why not offer them some primary care services to try to prevent more expensive emergency room costs? Second, I think it's unfair to demonize the potential beneficiaries of expansion. Are there some lazy, entitled assholes among them? Of course, but policymaking shouldn't be guided by the exceptions to the rule. Most of them work or have a debilitating condition or injury. Many are caregivers for their parents or young children. Some are working their way up to self-sufficiency, but haven't yet pulled themselves out of minimum wage territory.

I'm conflicted as well about expanding Mainecare but "why not offer them some primary care" is a really bad idea. Insurance or government payers are really inefficient ways to buy primary care. That's like using auto insurance to get your oil changed.

Buying routine primary care the same way you buy a week in the ICU or chemotherapy has made previously affordable primary care too expensive.

Rand Paul and the libertarians are right to question this whole mess.
A government in charge of taxation that targets certain non profit organizations because they aren't the right flavor for the current administration has absolutely no business dabbling in the dispensing of healthcare, IMO.

I don't believe our government has the right to stick a gun in my face and tell me I must give it money so they can give it to my neighbor for his health insurance. Health insurance is not a right. If I am forced to kick in bucks involuntarily, I want the gubbmint to be sure my neighbor does not conduct his life in such a way as to increase and abuse his use of the medical services the cost of which they are forcing me to pay. My neighbor must stop smoking now; he must quit abuse of all drugs...including alcohol; he must exercise regularly and loss the massive gut he is hauling around; give up or seriously reduce his glutinous consumption of sugar, carbohydrates, soda, chips, french fries and all such death or illness causing foods and, must get annual physicals et al. All of the foregoing cause illness and, since I am paying for his treatment, it is my call.

Under the current "free market" configuration......most middle income workers are subsidizing low or no income workers for medical care either through higher premiums or taxes.... either way we pay. Insurance companies are not in this for the exercise so I have no trust when they tell us that they are making no money....ditto for pharmaceutical robber barons and for profit medical monopolies .
I'll just throw this out there .What IF we did have a single payer system that everyone was paying into instead of the select few , no free ride. And the government administered it, you go to the doctor ,they submit the bill the government pays it( I know it's not quite simple but this is a hypothetical exercise).... how is that any more complicated or painful than what is currently happening for most of us?
BUT here is the real what if , what if the government didn't give any "work" to the insurance companies , there was no need for insurance companies to offer health insurance at all. Do you want to wager that the insurance companies would suddenly find a way to make health insurance more affordable???? Of course this will never happen because the congress is to busy kneeling and licking the insurance companies boots.....

@Watcher
This is what single-payer does. Since they're paying, they control everything. Your life decisions become their business, and Big Brother starts demanding that you live life how they think you should. No more freedom of choice.

Add government to health care? All decisions become political. You get expensive care if there's a political benefit (politically connected group), you don't if there isn't. The masses of poor get free primary care to buy their votes - but not expensive care, because that would be too expensive. And you get the bill since they don't pay taxes.

I have two main objections to expanding Medicaid. First, there's the phenomenon of people overusing services when they are free. I know it's anecdotal and drawn from a small sample, but the MaineCare recipients I have known run to the doctor or the ER for the most minor things, things that someone who has a deductible or co-pay that they have to pay aren't going to bother seeing a doctor for. Second, there's the cost transfer to the paying customers. Medicaid reimburses providers at such a low rate that they shift the cost of providing services to those who have insurance, making insurance more costly for those of us who pay for it ourselves.

Combine Medicaid patient's overuse of services with the cost shifting and I think you will find that expanding Medicaid is a much more expensive solution.

That would be only more so ,as the schedule of fed. contribution increases no matter the time table.
That small sample Roger is bad enough but gets even worse when they use a rescue to facilitate the
treatment.

The study to look at is the Oregon Medicaid experiment. At the time, they had enough money to offer Medicaid to a portion of a chunk of the poor population, but not all of them, so what they did was randomly offer Medicaid to a subset of that population.

At the same time, researchers tracked those who received and didn't receive Medicaid to see how they fared.

This is pretty much the dream conditions for understanding how people respond to government offered insurance.

The results, like most things in the real world, didn't really play into the conservative or the liberal narratives on government offered health care.

On one hand, it didn't reduce the number of ER visits - people were more likely to visit hospitals, get medication, receive treatment. On the other hand, it reduced the incidence of certain kinds of issues (for example, more people were diagnosed and treated for diabetes). It also reduced the incidence of depression and the chance that people would have unpaid medical bills (unsurprisingly).

There were no significant changes in mortality, but the study didn't really last long enough to measure the long term impact on health.

Also it's worth noting that while people do get treated for broken bones at the ER, you can't show up with cancer and get chemotherapy from the ER. Or get a knee replaced. Or get a tumor removed.

FWIW, one thing that bothers me (even as a liberal) is that medicaid seems to be really pretty good. It should suck. It should cover preventative and bare bones coverage of extreme things (childhood diseases) but that's it. You should have an incentive to move up, but not have to worry about your kid dying because you're poor.

Heard on Maine Public Broadcasting tonight (just before Antiques Roadshow) was the statement "Governor LePage has pledged to block virtually any plan to fund Medicaid expansion passed by voters". Totally twisting his words that said he would only approve a funded approach that did not use one-time gimmicks. Maybe MPBS can only imagine one-time gimmicks to fund this expansion instead of a responsible plan that cuts spending....

How do you know that "we" end up paying for the uninsured via emergency room write-offs? For what it's worth, there's much mixed evidence on this question.

And whether the beneficiaries of a medicaid expansion are worthy or deserving is beside the point in deciding whether to pay for the expansion. Of course, everyone is worthy; no kitten deserves to suffer. The question is, "What are the consequential results?"

Maine's fiscal problems - shrinking tax base and bloated expenditure - are the direct result of this sort of short-term temptation: let's accept the federal match to cover a few needy residents.

You are right, for sure. You can't keep prices down if you can't create a distinction between wealthy health care and poor health care.

But... you also don't want to have a system that keeps poor people impoverished and makes it easier for rich people to stay wealthy. That's just goes against everything Americans stand for.

While I do not endorse free boner pills and chemotherapy for all, I do think that not being able to get basic check ups and have access to preventative medicine (especially for children) is something that has a serious detrimental effect on the poor - much more than the middle or upper classes.

My recommendation would be make medicaid have shittier coverage (in terms of services) but broader (in terms of income class served). Of course, with today's Dems, that would probably make me a conservative.

In many, more urban states, medicaid coverage is good on paper, but difficult to use because providers limit the number of medicaid recipients they serve. If medicaid covered fewer, more essential services at higher reimbursement rates, your idea would become more practical.

It's also worth noting that there's evidence that health care for the lowest income groups costs more than for the highest groups, suggesting that factors other than paying for access drive health results.

I certainly don't favor a system that keeps poor people impoverished. However, I favor a system that makes it easier for rich people to stay wealthy. What American would want a system that made it hard for anyone to stay wealthy?

Mike, are you at all afraid that in today’s climate that kind of system leads to something like an aristocratic state, or feudalism masking as capitalism, instead of democratic capitalism? Wealth is becoming increasingly concentrated. Why do you want Joe Wallstreet to be able pass on millions and millions of dollars to his layabout son? Talk about disincentivizing work. And please don’t tell me that Joe’s son needs to hire lots of people to build his summer homes and take care of his boats and pick his toenails.

How do you know, as a general proposition, that inheritance disincentivizes work?

I don't care what Joe Wallstreet's son does with his inheritance; that's none of my business. Presumably, if he's an unenterprizing layabout, we don't need to worry about his using his wealth to become a feudal overlord.

All this is relevant except it diverts away from the immediate problem ,how are we going to pay for it ?

How we got here is an example of the fundamental problem with the voice of the people process.
It would be nice to really see how many really care about issue vs. we will vote for it because Le Page wouldn't accept it.

The referendum process needs to be looked at and like in this case proponents should be required to include fiscal impact and how it would be funded
as part of the choice before voting. It wasn't about any governor it was about fiscal impact on Maine tax payers for years.

Obamacare laid the groundwork for this, it was designed to fail and drive rates through the roof.It has accomplished exactly that.A Medicaid/single payer system will be the end result . Taxpayers will pay for it......they will eventually demand it thinking it is relief from the unending increase of insurance premiums......

It’s not sour grapes. You guys all talk about the DC swamp. Do you not see that wealth concentration is the product of the same kind of swamp? The Rs are passing a tax plan that will cut rates for the wealthiest, all in the name of growth and trickle down opportunity. But what actually happens? Influence and power and money compound. The “recovery” has almost exclusively benefitted the tip top “earners.” The 1% own 40% of the wealth in the US. The median income of the bottom 50% is $11k. The middle and lower class’s ability to earn has stagnated since 1980, while the folks with the most money have gotten much more wealthy. The ability to generate wealth and improve one’s economic lot in life really has very little to do with pluck, or smarts, or ideas, or foresight, or ingenuity, or any of the skills and attributes that we generally associate with capitalist enterprise anymore. It’s more about connection, and already having money. It’s an American version of aristocracy, and its disturbing.

I detest (what is called) crony capitalism, too. And I agree that influence-peddling and rent-seeking at the highest levels of government create cynicism and resentment. That's a bipartisan problem; e.g. Clinton Foundation, Solyndra.

So let's decide. Are any changes in the distribution of wealth necessarily due to corruption? If you want to discourage corruption do you punish honest capitalists with taxes on all wealth?

What if demographics (e.g. increase in proportion of retirement-age citizens, or assortive mating) also drive concentration of wealth? Or other trends (how about increasing returns to skills?) besides government policies?

Is there a difference between policies that reward corruption and policies that reward the creation of wealth?

Matt the federal minimum wage is$7.25 7.25 x40hours is$290 x 52 =$15,080 The minimum wage in Maine is currently $9 moving to $10 ,that’s $20,800 on a 40 hour week....... I doubt that 50% of he people who want to work are making $7.25 per hour....or a median income $11k....As to the one percent owning 40% of the wealth.....it may be true ,but there has always been a one percent.....the difference is there is so much more wealth to go around......A person who might be considered poor today has so much more materially and services wise than their parents or grandparents might have ever had.
I’ll never spend my time worrying about how to get rich people to give me more of their wealth or take it from them ,but rather how I can enhance my own lot by the talents and skills I posses....